Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes
Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes
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DOI：
10.1016/j.arthro.2007.08.016
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发表时间：
2008-08-01
影响因子：
4.7
通讯作者：
Altchek, David W.
中科院分区：
文献类型：
--
作者：
Brockmeier, Stephen F.;Dodson, Christopher C.;Altchek, David W.
在过头运动员中观察到一种独特类型的部分厚度肩袖撕裂，其特征是后冈上肌腱和前冈下肌腱的下表面部分失效，并伴有腱内分层。我们提出了一种使用不可吸收床垫缝合线进行经皮肌腱内修复的技术，旨在治疗关节侧分层部分厚度撕裂。在撕裂评估和准备之后，用抓紧器通过前外侧肩肌间隙入口将撕裂的肩袖下表面保持在缩小位置，同时观察关节内。然后将两根脊椎针经皮穿过撕裂且完整的肩袖的整个厚度。将聚二氧环己酮缝合线穿过每根针，从前门取出，并用于将单根不可吸收的 2 号缝合线穿过组织，形成床垫缝合线。可以根据撕裂大小和形态放置多条床垫缝合线，然后在肩峰下间隙进行缝合线回收和打结固定。我们采用这种方法的目的是在解剖学上重新建立肩袖插入并密封肌腱内分层区域，同时防止肩袖插入的解剖结构发生重大改变，这可能导致运动缺陷、内部撞击和潜在的撕裂复发。
A distinct type of partial-thickness rotator cuff tear has been observed in overhead athletes, characterized by partial failure of the undersurface of the posterior supraspinatus and anterior infraspinatus tendons with intratendinous delamination. We present a technique of percutaneous intratendinous repair using nonabsorbable mattress sutures designed for the management of articular-side delaminated partial-thickness tears. After tear evaluation and preparation, the torn rotator cuff undersurface is held in a reduced position with a grasper through an anterolateral rotator interval portal while viewing intra-articularly. Two spinal needles are then placed percutaneously through the full thickness of the torn and intact rotator cuff. A polydioxanone suture is passed through each needle, retrieved out the anterior portal, and used to shuttle a single nonabsorbable No. 2 suture through the tissue, creating a mattress suture. Multiple mattress sutures can be placed as dictated by tear size and morphology, with suture retrieval and knot securing then proceeding in the subacromial space. We have adopted this approach with the goals of anatomically re-establishing the rotator cuff insertion and sealing the area of intratendinous delamination while preventing significant alteration to the anatomy of the rotator cuff insertion, which could lead to motion deficits, internal impingement, and potential tear recurrence.